Provider Demographics
NPI:1568483907
Name:MYLES, WAYNE J (DO)
Entity type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:J
Last Name:MYLES
Suffix:
Gender:
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1702 LAFAYETTE RD
Mailing Address - Street 2:
Mailing Address - City:CRAWFORDSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47933-1033
Mailing Address - Country:US
Mailing Address - Phone:765-362-5100
Mailing Address - Fax:765-362-5171
Practice Address - Street 1:1702 LAFAYETTE RD
Practice Address - Street 2:
Practice Address - City:CRAWFORDSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47933-1033
Practice Address - Country:US
Practice Address - Phone:765-362-5100
Practice Address - Fax:765-362-5171
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1717207Q00000X
OH34006715207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH310917085219OtherOHIO MEDICAID CARESOURCE
OH2039654OtherOHIO MEDICAID MOLINA
OH292801OtherOHIO MEDICAID UNISON
OH2039654Medicaid
WV5630064000Medicaid
OHP00787559OtherRAILROAD MEDICARE
OH2039654OtherOHIO MEDICAID MOLINA
WV5630064000Medicaid
OH2039654Medicaid
OH000000634471OtherANTHEM
OHMY0843715Medicare ID - Type Unspecified